Heart Murmurs and Dentistry

The majority of people with heart murmurs used to get antibiotics prescribed before having dental work, but that is no longer the case, according to Dr. Morey Furman. He runs his own private practice in Garden City, New York, The Dental Office of Dr. Morey Furman, and talks here about how times have changed.

A heart murmur is an anatomical heart defect, which can actually be heard when listening to the heart beat. Reasons for having a heart murmur are numerous, including abnormally shaped heart valves or a hole in a wall leading to a chamber in the heart.

There used to be a philosophy that certain heart murmurs put you at risk for heart infections. For example, after having rheumatic fever, you often are left with a heart murmur. That’s because rheumatic fever can damage the heart valves, and a damaged heart valve is prone to infection. The reason it can be more prone to infection during a dental visit is because when you bleed from the mouth, bacteria from that area get into the bloodstream. If that travels to the heart with a damaged valve, for example, the bacteria can multiply and cause an infection.

One such infection is called SBE, or sub-acute bacterial endocartitis, which is a dangerous infection that can kill you without antibiotics. So for a long period of time, there was a philosophy that exposure to bacteria in the mouth, if it got into your bloodstream, can cause SBE.

For years, the thought was that certain heart murmurs from a mitral valve prolapse, a common heart murmur mostly in women, also could cause a heart infection due to mouth bacteria. So that is why for years, dentists gave patients with specific heart murmurs prophylactic antibiotics to prevent these sorts of infections from occurring.

Every few years, the American Heart Association reviewed this protocol. Over the years, they changed the dosage of antibiotics, and made other changes as well. The most recent change, about a year ago, actually says that there is not a significant risk of causing these infections from dental work – in most cases.

Where we once had to give antibiotics because of a heart murmur, just in case, now we rarely give it unless we know it is one of the rare murmurs where it is definitely called for. However, patients with heart murmurs who are used to receiving antibiotics now don’t always believe that they do not need them.

In some cases, they are nervous about it not getting antibiotics, so that can become an issue, a political issue concerning how to deal with it. With some patients, we keep prescribing antibiotics so they are comfortable; others we refer to their cardiologist to make an informed decision with them.

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